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COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA HEALTH PLAN 401k Plan overview

Plan NameCOMMUNITY HOSPITALS OF CENTRAL CALIFORNIA HEALTH PLAN
Plan identification number 501

COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA HEALTH PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Long-term disability cover
  • Other welfare benefit cover

401k Sponsoring company profile

COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA has sponsored the creation of one or more 401k plans.

Company Name:COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA
Employer identification number (EIN):942864615
NAIC Classification:622000
NAIC Description: Hospitals

Additional information about COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA

Jurisdiction of Incorporation: California Department of State
Incorporation Date:
Company Identification Number: C1122005

More information about COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA

Form 5500 Filing Information

Submission information for form 5500 for 401k plan COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA HEALTH PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-01-01
5012021-01-01
5012020-01-01
5012019-01-01
5012018-01-01
5012017-01-01ROGER FRETWELL
5012016-01-01ROGER FRETWELL
5012015-01-01ROGER FRETWELL
5012014-01-01ROGER FRETWELL
5012013-01-01ROGER FRETWELL
5012011-01-01ROGER FRETWELL
5012010-01-01ROGER FRETWELL
5012009-01-01ROGER FRETWELL

Plan Statistics for COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA HEALTH PLAN

401k plan membership statisitcs for COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA HEALTH PLAN

Measure Date Value
2022: COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA HEALTH PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-017,087
Total number of active participants reported on line 7a of the Form 55002022-01-017,516
Number of retired or separated participants receiving benefits2022-01-0189
Total of all active and inactive participants2022-01-017,605
2021: COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA HEALTH PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-017,132
Total number of active participants reported on line 7a of the Form 55002021-01-017,016
Number of retired or separated participants receiving benefits2021-01-0135
Total of all active and inactive participants2021-01-017,051
2020: COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA HEALTH PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-018,944
Total number of active participants reported on line 7a of the Form 55002020-01-016,920
Number of retired or separated participants receiving benefits2020-01-0198
Total of all active and inactive participants2020-01-017,018
2019: COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA HEALTH PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-018,278
Total number of active participants reported on line 7a of the Form 55002019-01-017,029
Number of retired or separated participants receiving benefits2019-01-0165
Total of all active and inactive participants2019-01-017,094
2018: COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA HEALTH PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-017,425
Total number of active participants reported on line 7a of the Form 55002018-01-016,887
Number of retired or separated participants receiving benefits2018-01-0169
Total of all active and inactive participants2018-01-016,956
2017: COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA HEALTH PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-017,319
Total number of active participants reported on line 7a of the Form 55002017-01-016,930
Number of retired or separated participants receiving benefits2017-01-0158
Total of all active and inactive participants2017-01-016,988
2016: COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA HEALTH PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-016,593
Total number of active participants reported on line 7a of the Form 55002016-01-016,848
Number of retired or separated participants receiving benefits2016-01-0147
Total of all active and inactive participants2016-01-016,895
2015: COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA HEALTH PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-016,142
Total number of active participants reported on line 7a of the Form 55002015-01-016,546
Number of retired or separated participants receiving benefits2015-01-0147
Total of all active and inactive participants2015-01-016,593
Total participants2015-01-010
2014: COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA HEALTH PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-015,962
Total number of active participants reported on line 7a of the Form 55002014-01-016,094
Number of retired or separated participants receiving benefits2014-01-0148
Total of all active and inactive participants2014-01-016,142
Total participants2014-01-010
2013: COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA HEALTH PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-015,364
Total number of active participants reported on line 7a of the Form 55002013-01-015,907
Number of retired or separated participants receiving benefits2013-01-0155
Total of all active and inactive participants2013-01-015,962
Total participants2013-01-010
2011: COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA HEALTH PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-014,771
Total number of active participants reported on line 7a of the Form 55002011-01-015,026
Number of retired or separated participants receiving benefits2011-01-0171
Total of all active and inactive participants2011-01-015,097
Total participants2011-01-015,097
2010: COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA HEALTH PLAN 2010 401k membership
Total participants, beginning-of-year2010-01-014,907
Total number of active participants reported on line 7a of the Form 55002010-01-014,771
Number of retired or separated participants receiving benefits2010-01-0163
Total of all active and inactive participants2010-01-014,834
Total participants2010-01-014,834
2009: COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA HEALTH PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-014,530
Total number of active participants reported on line 7a of the Form 55002009-01-014,907
Number of retired or separated participants receiving benefits2009-01-0148
Total of all active and inactive participants2009-01-014,955
Total participants2009-01-014,955

Form 5500 Responses for COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA HEALTH PLAN

2022: COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA HEALTH PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Plan funding arrangement – General assets of the sponsorYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – General assets of the sponsorYes
2021: COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA HEALTH PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Plan funding arrangement – General assets of the sponsorYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – General assets of the sponsorYes
2020: COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA HEALTH PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Plan funding arrangement – General assets of the sponsorYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – General assets of the sponsorYes
2019: COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA HEALTH PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Plan funding arrangement – General assets of the sponsorYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – General assets of the sponsorYes
2018: COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA HEALTH PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Plan funding arrangement – General assets of the sponsorYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – General assets of the sponsorYes
2017: COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA HEALTH PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – General assets of the sponsorYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – General assets of the sponsorYes
2016: COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA HEALTH PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan funding arrangement – General assets of the sponsorYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – General assets of the sponsorYes
2015: COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA HEALTH PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – InsuranceYes
2014: COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA HEALTH PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – InsuranceYes
2013: COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA HEALTH PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – InsuranceYes
2011: COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA HEALTH PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – InsuranceYes
2010: COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA HEALTH PLAN 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan benefit arrangement – InsuranceYes
2009: COMMUNITY HOSPITALS OF CENTRAL CALIFORNIA HEALTH PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

COMMUNITY CARE HEALTH PLAN INC (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberN/A
Policy instance 3
Insurance contract or identification numberN/A
Number of Individuals Covered8604
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $48,253,469
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number30028152
Policy instance 2
Insurance contract or identification number30028152
Number of Individuals Covered7384
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number76489
Policy instance 1
Insurance contract or identification number76489
Number of Individuals Covered1584
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $232,396
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
COMMUNITY CARE HEALTH PLAN INC (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberN/A
Policy instance 3
Insurance contract or identification numberN/A
Number of Individuals Covered3752
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $46,975,604
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number30028152
Policy instance 2
Insurance contract or identification number30028152
Number of Individuals Covered6899
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number76489
Policy instance 1
Insurance contract or identification number76489
Number of Individuals Covered1440
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $206,307
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number76489
Policy instance 1
Insurance contract or identification number76489
Number of Individuals Covered1238
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $177,038
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number30028152
Policy instance 2
Insurance contract or identification number30028152
Number of Individuals Covered7008
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
COMMUNITY CARE HEALTH PLAN INC (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberN/A
Policy instance 3
Insurance contract or identification numberN/A
Number of Individuals Covered3752
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $45,344,599
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
COMMUNITY CARE HEALTH PLAN INC (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberN/A
Policy instance 3
Insurance contract or identification numberN/A
Number of Individuals Covered2431
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number30028152
Policy instance 2
Insurance contract or identification number30028152
Number of Individuals Covered6911
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number76489
Policy instance 1
Insurance contract or identification number76489
Number of Individuals Covered970
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $148,059
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number30028152
Policy instance 2
Insurance contract or identification number30028152
Number of Individuals Covered6814
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number402270G
Policy instance 4
Insurance contract or identification number402270G
Number of Individuals Covered7396
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $90,741
Total amount of fees paid to insurance companyUSD $53,476
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $2,011,581
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $67,503
Amount paid for insurance broker fees17410
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 )
Policy contract numberGF3860066717-01
Policy instance 3
Insurance contract or identification numberGF3860066717-01
Number of Individuals Covered7436
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $64,498
Total amount of fees paid to insurance companyUSD $29,640
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,262,943
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $41,984
Amount paid for insurance broker fees10392
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION
Insurance broker organization code?3
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number76489
Policy instance 1
Insurance contract or identification number76489
Number of Individuals Covered1109
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $160,810
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 )
Policy contract numberGF3860066717-01
Policy instance 3
Insurance contract or identification numberGF3860066717-01
Number of Individuals Covered8457
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $14,589
Total amount of fees paid to insurance companyUSD $5,145
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $321,385
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $14,589
Amount paid for insurance broker fees3546
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION
Insurance broker organization code?3
Insurance broker nameAON RISK SERVICES CENTRAL INC
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number76489
Policy instance 1
Insurance contract or identification number76489
Number of Individuals Covered1011
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $148,769
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number30028152
Policy instance 2
Insurance contract or identification number30028152
Number of Individuals Covered6687
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number402270G
Policy instance 4
Insurance contract or identification number402270G
Number of Individuals Covered7323
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $100,004
Total amount of fees paid to insurance companyUSD $33,215
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $1,803,322
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $100,004
Amount paid for insurance broker fees33215
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
Insurance broker nameTOWERS WATSON DELAWARE INC
COMMUNITY CARE HEALTH PLAN INC (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberN/A
Policy instance 1
Insurance contract or identification numberN/A
Number of Individuals Covered1782
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 )
Policy contract number170202
Policy instance 2
Insurance contract or identification number170202
Number of Individuals Covered6546
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of fees paid to insurance companyUSD $1,140,847
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees1140847
Additional information about fees paid to insurance brokerTHE SERVICES, AND FEES, AS SET FORTH IN THE ADMINISTRATIVE AGREEMENT.
Insurance broker nameANTHEM BLUE CROSS LIFE AND HEALTH
COMMUNITY CARE HEALTH PLAN INC (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberN/A
Policy instance 1
Insurance contract or identification numberN/A
Number of Individuals Covered1819
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 )
Policy contract number170202
Policy instance 2
Insurance contract or identification number170202
Number of Individuals Covered6094
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of fees paid to insurance companyUSD $1,172,514
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees1172514
Additional information about fees paid to insurance brokerTHE SERVICES, AND FEES, AS SET FORTH IN THE ADMINISTRATIVE AGREEMENT.
Insurance broker nameANTHEM BLUE CROSS LIFE AND HEALTH
ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 )
Policy contract number170202
Policy instance 2
Insurance contract or identification number170202
Number of Individuals Covered5907
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of fees paid to insurance companyUSD $786,109
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees786109
Additional information about fees paid to insurance brokerTHE SERVICES, AND FEES, AS SET FORTH IN THE ADMINISTRATIVE AGREEMENT.
Insurance broker nameANTHEM BLUE CROSS LIFE AND HEALTH
BLUE CROSS OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number275275
Policy instance 1
Insurance contract or identification number275275
Number of Individuals Covered1363
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $310,083
Total amount of fees paid to insurance companyUSD $33,433
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $11,410,329
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $310,083
Amount paid for insurance broker fees33433
Insurance broker organization code?3
Insurance broker nameVILLANE WARD INSURANCE SERV INC.
BLUE CROSS OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number275275
Policy instance 2
Insurance contract or identification number275275
Number of Individuals Covered1220
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $142,966
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $9,334,588
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 )
Policy contract number170202
Policy instance 1
Insurance contract or identification number170202
Number of Individuals Covered3807
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of fees paid to insurance companyUSD $648,056
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 )
Policy contract number170202
Policy instance 1
Insurance contract or identification number170202
Number of Individuals Covered3138
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of fees paid to insurance companyUSD $557,763
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees557763
Additional information about fees paid to insurance brokerTHE SERVICES, AND FEES, AS SET FORTH IN THE ADMINISTRATIVE AGREEMENT.
Insurance broker nameANTHEM BLUE CORSS LIFE AND HEALTH
BLUE CROSS OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number275275
Policy instance 2
Insurance contract or identification number275275
Number of Individuals Covered1633
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $170,098
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $12,300,986
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $170,098
Insurance broker organization code?3
Insurance broker nameAHART BENEFIT INSURANCE SERVICES

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